Terra Sigillata

“. . .you got marijuana in my lead.”

Two great tastes that do not go great together (with apologies).

[Welcome Fark.com readers on 12 Oct 2008 - I comment on the recent story here and you can read our other posts on drugs of abuse here. Thanks for stopping by - APB]

A concise but fascinating medical detective story appears in the letters of this week’s (10 Apr 2008) issue of the New England Journal of Medicine (free full text at the time of this posting.).

An astute group of physicians at Leipzig Hospital in Germany noted a local surge of young people presenting with classic symptoms of lead poisoning – 29 patients aged 16 to 33 over the course of 3-4 months. Patients exhibited symptoms ranging from abdominal cramps, nausea, and “Burton’s line” to hematologic pathologies such as anemia and basophilic stippling (overview). Burton’s line, illustrated here in another NEJM image from a lead poisoning case, results from “the reaction of circulating lead with sulfur ions released by oral microbial activity [that] may cause the deposition of lead sulfide at the interface of the teeth and gums.”

In another hospital in Leipzig, one patient was so severely poisoned that they had severe encephalopathy with hallucinations and permanent palsy in one forearm.

None of the patients were in any industry, such as lead-smelting, where today’s rare cases of lead poisoning still occur. Instead, they were young smokers with body piercings, either students or unemployed.

The diagnosis was quickly established, and chelation therapy was effective, but despite great efforts by health authorities and police, the source of lead could not be identified.

Yes, this is the one evidence-based indication for chelation therapy, usually with aminocarboxylate (calcium EDTA) or sulfur-containing compounds (2,3-dimercaptosuccinic acid; DMSA; succimer; Chemet^®) to complex the lead with very high affinity and enhance its urinary excretion.

What else was common to these patients?

Upon further questioning, all patients admitted to smoking marijuana. Was this a case of marijuana being grown in soil with high lead content?

When some patients provided the investigators with samples of their stash, one showed visual evidence of lead particles (photo).

At this point, we involved the police, and a full criminal investigation was begun. Health authorities immediately started an anonymous screening program for marijuana users. After 2 weeks, 145 persons had used this service. A total of 95 of these persons had blood lead levels that required treatment (>25 μg per deciliter), and some of these persons had dangerous levels of lead (>80 μg per deciliter).

The lead doping of dope, as it were, was so pervasive in the area that 66% of those screened had clinical lead poisoning. By now, you can probably guess the probable reason for lead in the marijuana:

The current working hypothesis of the police is that because of its high specific gravity and inconspicuous grayish color, lead was used to increase the weight of street marijuana sold by the gram and thereby to maximize profits among dealers. In the material that was obtained, the lead content on average was 10% by weight, which translates into a profit increase of approximately €1,000 ($1,500.00) per kilogram of marijuana.

While exposure to lead has decreased worldwide, physicians should renew their familiarity with the clinical signs of acute lead poisoning and include this possibility in the differential diagnosis of neurological symptoms in suspected marijuana users. You can bet that the economic aspect of this story will resonate with drug dealers, if it hasn’t already, and I wouldn’t surprised if lead poisoning becomes more widespread among marijuana users.

Lead particles smoked in a joint, which can have a core temperature of 1200°C, are very effectively absorbed in the respiratory tract. The medical community, including pediatricians, should consider adulterated marijuana as a potential source of lead intoxication.

And while we would never condone the use of illegal substances among our readers or their friends and other loved ones, a visual inspection of marijuana supplies for lead particulate would be advisable for recreational users.

Mega props to our colleagues in Germany at University Hospital Leipzig and Dialysis Center Grimma for their superb detective work and communication of these cases with the international medical community.

Busse, F., Omidi, L., Leichtle, A., Windgassen, M., Kluge, E., Stumvoll, M. (2008). Lead Poisoning Due to Adulterated Marijuana. New England Journal of Medicine, 358(15), 1641-1642. (free full text at the time of this posting.)

Comments

#1 Abbie
April 12, 2008

Well, that’s another reason it should be legalized and regulated.

And while we would never condone the use of illegal substances among our readers

Why not? Marijuana should be legal, and it’s prohibition, like the laws against sodomy, should be openly denounced.
#2 PhysioProf
April 12, 2008

“inconspicuous grayish color”

A least in the dime bag shown in the NEJM photo, it sure as fuck didn’t look “inconspicuous” to me. It looked like a bag full of metal shavings with a couple pieces of bud.
#3 bill
April 12, 2008

PP — they got that bag from a patient. Would you have handed over a full bag? Of course they got an empty.

But yeah, the metal particles were obvious — and even if I didn’t realize it was lead, I’d ask my supplier wtf metal was doing in my herb!

Plus, I’ve had lead in my mouth — I used to fish, and sometimes you forget the crimping pliers, OK? — and it tastes horrible. Surely with that much in a doob one would notice that something was off?

Abbie — I’m with you. I don’t actually use dope, but I do drink alcohol and I don’t see why one is perfectly legal and the other will get you a criminal record.
#4 DuWayne
April 12, 2008

This is a new one for me. I would guess that this hasn’t yet become very popular in the U.S.

Unfortunately, there are some nasty ways for upping the weight that are relatively common in the U.S. One that is possibly as bad as the lead, is the use of shellac. This has the dual effect of adding weight and making the buds look brighter and more attractive. Not quite as bad when food grade shellac is used, but that is a rarity, because it is harder to come by.

I have also heard of pesticides being used, more common with “shwag” or compressed marijuana, usually from Mexico. Rather than being used to add weight, it is actually being used for it’s intended purpose. The major problem being, that people generally don’t wash their weed.

Probably the most common method for adding weight is entirely benign. Spritzing the marijuana with water will add plenty of weight and can actually make the weed burn a little more slowly which many tokers prefer.

For my own part, I haven’t smoked pot in years, that wasn’t grown by someone I know. Mostly grown by people who are legally entitled to grow it and don’t have any reason to add weight.

And while we would never condone the use of illegal substances among our readers or their friends and other loved ones

For some of us, it is legal, at least according to state statute. As long as it doesn’t cross state lines, the feds usually don’t get involved.

I will definitely keep this in mind though. I have been in discussions with Portland Parks and Recreation about doing a drug program at some of the local community centers. I got the idea during a neighborhood meeting with some of our neighborhood cops.

They said they could probably provide at least one drug cop, a contract lab tech and some meth or crack that has been slated for destruction. They would then discuss the analysis of the sample we have as well as discussing what has been found in various samples of different drugs that they have seized and tested.

There is a lot of resistance to the idea, mainly because the approach taken would not really involve saying just say no. I suggested that taking a values neutral approach would be the best approach. Just have a straightforward discussion about exactly what’s in the drugs that are common on the streets here. There is a lot of support for it as well though, especially among our community policing neighborhood liaison officers

The nicest aspect for me, is that it would be a program that I am not actually directly involved with. I have a couple other programs that I would like to do and adding yet another would just be too much.
#5 Whacky Supplement User
April 12, 2008

Just for fun: If MJ were legalized, would it be regulated as a supplement or a drug?

Probably a drug.

Then it would be subject to full drug testing. Which, as noted on the other thread, adds a lot of cost.

Consequently, many of the people who use it recreationally now would no longer be able to afford it. But it might be added to some insurance companies’ formularies, so that most of those who had it prescribed would still be able to afford it.

But the recreational users, the vast majority, would still want it at the accustomed price, so the infrasturcture that currently provides it would still have incentives to make non-regulated varieties, yes? And, adding one more department of government to their efforts hardly seems like much of a deterrent.

So, while legalizing and regulating MJ would make it safer and more effective for those who -need- it, it’s unlikely it would be much help for those who merely -want- it.

Yes? No? Maybe?
#6 PalMD
April 13, 2008

Actually, alcohol is regulated, but neither as a supplement nor as a pharmaceutical (except as pure ethanol), so I’m sure a category could be created.
#7 DuWayne
April 13, 2008

WSU -

Why would it be either of those? As PalMD mentions, we regulate alcohol as neither of those things, why would we put marijuana (or other drugs, as I personal advocate legalizing, taxing and regulating far more than just the weed) in a different category?

However, in my state, it is legal for medical use and the price has actually stayed lower than it is in other parts of the country. For those with providers licensing, it is totally legal for them to grow and sell it to people with medical marijuana cards. Reducing the risk and having a fairly steady group of customers, makes it easier to lower the price a bit.
#8 irv
April 14, 2008

Damn Chinese reefer.
#9 Peter
October 12, 2008

The only way someone could be stupid enough not to see the metal in that picture is if they were smoking lead.

I smoke, but I’m quitting. I started because of boredom, but I’m quitting for health reasons. This article gives me another reason.
#10 Marijuana Treatment
November 28, 2008

There are many marijuana treatment centers available in USA. These centers offer the best treatment to their patients and they become a younger appearance and to gain more self confidence.

http://www.edrugrehabs.com/SubstanceAbuse/Marijuana-Addiction-Treatments/Rehabs/index.html
#11 k2 incense
July 20, 2010

Yeah, look at all that lead in the photo. That’s pretty scary.